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2A revision > Urogenital > Flashcards

Urogenital Flashcards

1
Q

diagnosing scrotal masses

A
  1. can you get above it?
  2. is it separate from the testis?
  3. cystic or solid?
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2
Q

what is it if you can’t get above a scrotal mass

A

inguinoscrotal hernia

hydrocele extending proximally

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3
Q

what is a separate and cystic scrotal mass

A

epididymal cyst

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4
Q

what is a separate and solid scrotal mass

A

epididymitis / varicocele

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5
Q

what is a testicular and cystic scrotal mass

A

hydrocele

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6
Q

what is a testicular and solid scrotal mass

A

tumour, haematocele, granuloma, orchitis

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7
Q

what is an epididymal cyst and what is it caused by

A
  • benign cyst lesion of the epididymis

- possibly from obstruction of the epididymis

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8
Q

clinical manifestations of epididymal cyst

A
  • small paratesticular swelling
  • tender
  • thin-walled, translucent cystic lesion
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9
Q

what is the management of epididymal cyst

A
  • remove if symptomatic
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10
Q

what is a hydrocele

A
  • an abnormal accumulation of fluid in the space between the two layers of the tunica vaginalis
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11
Q

causes of hydrocele

A

primary cause = trauma

secondary cause = reaction to underlying pathology (epididymitis, orchitis, tumour)

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12
Q

clinical manifestations of a hydrocele

A
  • scrotal swelling
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13
Q

management of a hydrocele

A
  • can resolve spontaneously
  • aspiration
  • surgery = placating the tunica vaginalis/ inverting the sac
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14
Q

what is a varicocele

A

a persistent abnormal dilation of the pampiniform venous plexus in the spermatic cord

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15
Q

clinical manifestations of a varicocele

A
  • nodularity on the lateral side of the scrotum
  • dull ache (worse after prolonged standing)
  • male subfertility (increased blood flow raises temp and impairs spermatogenesis)
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16
Q

management of varicocele

A

surgery to remove

if untreated can lead to infertility

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17
Q

what is an adenomatoid tumour

A
  • most common benign paratesticular neoplasm

- small, solid, grey/white tumours <3cm

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18
Q

where do adenomatoid tumours occur

A

epididymis, spermatic cord, tunica albuginea

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19
Q

causes of urinary tract obstruction

A 
urinary stones
urothelial tumours
extrinsic compression
prostatic hyperplasia 
urinary tract malformations
strictures
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20
Q

clinical manifestations of acute upper tract obstruction

A

ureteric colic (pain radiates to groin)
superimposes infection
enlarged kidney

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21
Q

clinical manifestations of chronic upper tract obstruction

A

flank pain, renal failure, superimposed infection,

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22
Q

clinical manifestations of acute lower tract obstruction

A

acute urinary retention, severe suprapubic pain, acute confusion

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23
Q

clinical manifestations of chronic lower tract obstruction

A

urinary frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence

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24
Q

investigations for urinary tract obstruction

A
  • bloods (U&E, FBC, creatinine, PSA)
  • urine dipstick and MC&S
  • US = hydronephritis (swelling of kidney) or hydroureter
  • CT = level of obstruction
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25
Q

treatment of urinary tract obstruction

A
  • upper = nephrostomy or ureteric stent

- lower = urethral or suprapubic catheter

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26
Q

complications of urinary tract obstruction

A

-risk of infection, stone formation, renal damage

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27
Q

what can cause haematuria

A
  • malignancy
  • calculi
  • IgA nephropathy
  • polycystic kidney disease
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28
Q

management of haematuria

A
  • urological assessment, imaging, cystoscopy to exclude malignancy and calculi
  • renal referral
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29
Q

clinical manifestation of testicular torsion

A
  • sudden onset pain in one testis and abdomen
  • nausea and vomiting common
  • tender, hot, swollen testicle
  • testis may lie high and transversely
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30
Q

differential diagnosis for testicular torsion

A
  • epididymo-orchitis = symptoms of urinary infection and more gradual onset of pain
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31
Q

investigations for testicular torsion

A
  • doppler US = lack of blood flow to a testicle

- do not delay surgical exploration

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32
Q

management of testicular torsion

A
  • possible orchidectomy + bilateral fixation

- surgery to expose and untwist the testis

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33
Q

what is benign prostatic hyperplasia

A
  • enlargement of the prostate gland due to an increase in cell number
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34
Q

pathology of BPH

A
  • increased levels of dihydrotestosterone in prostate (androgen)
  • increased oestrogen levels in blood induce androgen receptors in prostate tissue and stimulate hyperplasia
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35
Q

clinical manifestations of BPH

A
  • LUTS = frequency, urgency, nocturia, hesitancy, poor flow, terminal dribbling
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36
Q

differential diagnoses of BPH

A
  • overactive bladder, prostatitis, prostate cancer, UTI
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37
Q

investigations for BPH

A
  • U&E
  • US
  • PSA test
  • biopsy
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38
Q

management for BPH

A
  • lifestyle = avoid caffeine and alcohol. void twice in a row
  • drugs = tamsulosin (alpha-blockers)
  • surgery = transurethral resection or incision of prostate, retropubic prostatectomy
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39
Q

complications of BPH

A
  • urinary retention
  • recurrent UTI
  • bladder stones
  • obstructive nephropathy
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40
Q

what is a renal carcinoma

A

malignant epithelial neoplasm arising in the kidney

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41
Q

clinical manifestations of renal carcinoma

A
  • half present with painless haematuria
  • picked up incidentally on imaging
  • small proportion present with metastatic disease
  • loin pain, abdo mass, anorexia, weight loss, malaise.
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42
Q

investigations for renal carcinoma

A
  • hypertension from renin secretion
  • FBC = polycythaemia from erythropoietin secretion
  • ESR, U&E, ALP
  • urine = RBCs
  • US, CT/MRI, CXR
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43
Q

management of renal carcinoma

A
  • radical nephrectomy

- cryotherapy and radiofrequency ablation if not fit for surgery

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44
Q

what is a nephroblastoma - Wilm’s tumour

A
  • malignant childhood renal neoplasm
  • abdominal mass and haematuria
  • most low stage with good prognosis
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45
Q

what is a urothelial carcinoma (bladder transitional cell carcinoma)

A
  • a group of urothelial neoplasms arising in the urothelial tract
46
Q

clinical manifestations of urothelial carcinoma

A
  • painless haematuria
  • LUTS
  • recurrent UTI
  • voiding irritability
47
Q

investigations for urothelial carcinoma (bladder cancer)

A
  • urine cytology
  • IVU
  • cystoscopy and biopsy
  • CT/ MRI
48
Q

management of urothelial carcinoma (bladder cancer)

A
  • Tis/Ta/T1 (80% of patients) = transurethral cystoscopy/resection of bladder tumour
  • T2-3 = radical cystectomy (radiotherapy if need to preserve the bladder)
  • T4 = palliative chemo/radiotherapy, chronic catheterisation and urinary diversions
49
Q

what is prostate carcinoma

A

malignant epithelial tumour arising in the prostate

50
Q

pathology of prostate cancer

A
  • arise from precursor lesion (prostatic intraepithelial neoplasia) with neoplastic transformation of the epithelium lining of the prostatic ducts and acini.
  • mutations in a number of genes
51
Q

clinical manifestations of prostate cancer

A
  • asymptomatic
  • LUTS
  • symptoms of metastatic disease
52
Q

investigations for prostate cancer

A
  • often diagnosed through needle biopsy to investigate raised serum PSA
  • DRE = hard, irregular prostate
  • increased PSA levels
  • biopsy
53
Q

management of prostate cancer

A
  • prostatectomy
  • radiotherapy
  • analgesia
  • treat hypercalcaemia
54
Q

what are the two testicular tumours

A
  • seminoma = germ cell tumour of the testicle

- teratoma = non-germ cell tumour of the testicle

55
Q

clinical manifestations of testicular tumour

A
  • painless testis lump after trauma/infection
  • secondary hydrocele
  • pain
  • dyspnoea
  • abdo mass
56
Q

differential diagnosis of testicular tumour

A
  • hydrocele
  • abdominal hernias
  • orchitis
57
Q

investigations for testicular tumours

A
  • CXR
  • CT
  • excision biopsy
  • alpha-FP and beta-hcg useful tumour markers to monitor treatment
58
Q

tumour staging of testicular tumours (1-4)

A
  1. no evidence of metastasis
  2. infradiaphragmatic node involvement
  3. supradiaphragmatic node involvement
  4. lung involvement (haematogenous spread)
59
Q

management of testicular tumours

A
  • radical orchidectomy
  • seminomas are very radiosensitive
  • chemo = teratoma
  • radiotherapy = seminoma
60
Q

what is urolithiasis - urinary tract calculi (nephrolithiasis)

A
  • formation of stony concretions in the bladder or urinary tract
61
Q

pathology of urolithiasis

A
  • calculi form leading to blockage and abrasing structures.

- renal stones = crystal aggregates, form in collecting ducts and deposit anywhere from renal pelvis to urethra

62
Q

where are renal stones classically deposited (3)

A
  1. pelviureteric junction
  2. pelvic brim
  3. vesicoureteric junction
63
Q

risk factors for renal stones/ urolithiasis

A
  • high protein/ salt intake
  • male, white
  • obesity
  • dehydration
  • meds = antacids, carbonic anhydrase inhibitor
  • crystal urea
  • increase in urinary solutes (calcium, uric acid, oxalate, sodium) and a decrease in stone inhibitors (citrate, magnesium)
64
Q

what can renal stones be formed from

A
  • calcium oxalate/ calcium phosphate (hyperparathyroidism, excess dietary calcium, primary renal disease)
  • magnesium ammonium phosphate
  • uric acid (hyperuricaemia, dehydration)
  • struvite (chronic UTI)
  • cystine stones
65
Q

what are urinary calculi

A
  • renal stones

- crystal aggregates which form in the renal collecting ducts and become deposited in the urinary tract

66
Q

what are triple stones

A
  • result of infections (eg proteus) that produce the enzyme urease which splits urea to ammonia
67
Q

presentation of renal stones

A
  • fever, vomiting, flank pain
  • most asymptomatic
  • stones causing obstruction lead to hydronephritis (obstruction + dilation of renal pelvis causing lasting damage)
  • larger stones tend to remain confined to the kidney
  • smaller stones tend to pass into ureter and and become impacted causing ureteric colic
  • infection, haematuria, proteinuria, sterile pyuria
68
Q

where is pain felt for obstruction of the kidney, mid-ureter, lower ureter and bladder/urethra?

A
  • kidney = felt in loin
  • mid-ureter = mimic appendicitis
  • lower ureter = bladder irritability and pain in scrotum, penile tip or labia majora
69
Q

investigations for renal stones

A

CT = gold standard

  • Xray to detect kidney stones
  • urine dipstick = blood
  • 24h urine sample for stone biochemistry
  • US = hydronephrosis
70
Q

acute management of renal stones/urolithiasis

A
  • NSAIDs for pain
  • antiemetics for vomiting and nausea
  • allow stones <5mm to pass spontaneously
  • IV fluids
71
Q

surgical management of renal stones/ urolithiasis

A
  • percutaneous nephrostomy (drain urine straight from kidney = symptom relief)
  • ureteric stent
  • percutaneous nephrolithotomy = remove stone from the kidney by small puncture of skin
  • endoscopic/open surgery to break down stone
  • extracorporeal shock wave lithotripsy = uses shock waves to break down stones so fragments can be passed
72
Q

prevention of renal stones

A
  • overhydration
  • low salt diet
  • normal dairy intake
  • healthy protein intake
  • reduce BMI
  • active lifestyle
73
Q

lower urinary tract infections

A
  • cystitis
  • prostatitis
  • epididymitis/ orchitis
  • urethritis
74
Q

upper urinary tract infections

A

pyelonephritis

75
Q

classification of urinary tract infections

A
  • asymptomatic bacteriuria
  • uncomplicated (normal renal structure and function)
  • complicated (structural/ functional abnormality)
76
Q

what is the main pathogen that causes UTI

A

Escherichia coli

77
Q

why are omen more susceptible to UTI

A

shorter urethra so closer proximity to anus

78
Q

presentation of cystitis (bladder infection)

A
  • frequency, urgency, dysuria, haematuria, suprapubic pain
79
Q

what is the presentation of ascending spread to the kidneys (acute pyelonephritis)

A
  • more severe

- fever, rigors, vomiting, loin pain

80
Q

diagnosis of UTI

A
  • urinalysis = leucocytes or nitrates = quick screening test
  • look for protein, blood, pH, ketones, glucose, leucocytes an nitrates
  • microscopy = WBCs, RBCs, casts and bacteria
  • microbiological culture (midstream specimen)
81
Q

management of uncomplicated UTI

A
  • Abx for 3 days

- if fails then culture urine and treat according to Abx sensitivity

82
Q

management of UTI in men

A
  • lower UTI with 7 day Abx course

- if prostatitis then give a course of ciprofloxacin (able to penetrate prostatic fluid)

83
Q

management of complicated UTI

A

7day Abx

84
Q

management of UTI in pregnant women

A
  • asymptomatic bacteriuria should be confirmed on a second sample
  • Abx
85
Q

what is prostatitis

A
  • inflammation/swelling of the prostate gland

- ascending infection from the urinary tract or haematogenous spread

86
Q

clinical presentation of prostatitis

A

pain = perineum, rectum, scrotum, penis, bladder, lower back

  • fever
  • malaise
  • nausea
  • urinary symptoms
87
Q

treatment of acute prostatitis

A
  • Abx treatment for 28days immediately

- treat pain

88
Q

treatment of chronic prostatitis

A
  • pain relief
  • stool softener
  • Abx 4-6 weeks
89
Q

what is cystitis

A
  • inflammation of the bladder caused by bladder infection (UTI, E.coli)
90
Q

symptoms of cystitis

A
  • frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria
91
Q

what is pyelonephritis

A

infection of the renal parenchyma and soft tissues of the renal pelvis/ upper ureter

92
Q

symptoms of pyelonephritis

A
  • loin pain, fever, pyuria (puss in urine)
  • vomiting
  • cystitis symptoms
  • septic shock
93
Q

investigations for pyelonephritis

A
  • abdo examination = tender loin
  • bloods and cultures
  • US scan to rule out upper tract obstruction
94
Q

treatment of pyelonephritis

A
  • fluid replacement
  • broad spec IV Abx (c-amoxiclav)
  • drain obstructed kidney
  • analgesia
95
Q

what is urethritis

A

inflammation of the urethra

96
Q

pathology of urethritis

A
  • mostly sexually transmitted
  • gonorrhoea
  • chlamydia trachomatis
  • needs sexual health referral
97
Q

treatment of urethritis

A
  • depends on cause
  • gonorrhoea = ceftriaxone
  • bacteria = oflaxacin
  • chlamydia = doxycycline
98
Q

presentation of urethritis

A
  • painful/difficult urination
99
Q

what is epididymo-orchitis

A

inflammation of the epididymis +/- testes

100
Q

causes of epididymo-orchitis

A
  • chlamydia
  • e.coli
  • mumps
  • n.gonorrhoea
101
Q

pathology of epididymo-orchitis

A
  • sexually transmitted infection ascending from the urethra or non-sexually transmitted uropathogens spreading from urinary tract
102
Q

features of epididymo-orchitis

A
  • sudden onset tender swelling, dysuria, fever, urethral discharge
  • possible infertility
  • symptoms way worsen before improving
103
Q

treatment of epididymo-orchitis

A
  • doxycycline
  • sexual abstinence and contact tracing
  • analgesia and drainage of any abscess
104
Q

genital ulcers

A
  • HSV
  • flu-like prodrome, vesicles/papules around genitals, anus, throat = burst forming shallow ulcers
  • urethral discharge, dysuria, urinary retention, proctitis
  • diagnosis via PCR
105
Q

treatment of genital ulcers

A
  • analgesia = topical lidocaine
106
Q

syphilis

A
  • any genital ulcer is syphilis until proven otherwise
  • primary= genital skin, nipples, mouth
  • secondary = onset after infection, skin rash
  • incubation 9-90 days (usually 21-35 days)
107
Q

diagnosis of syphilis

A
  • PCR
  • early moist lesions
  • serology
108
Q

treatment of syphilis

A
  • penicillin injection

- follow up and partner notification essential

109
Q

chlamydia diagnosis

A
  • nucleic acid amplification test (NAAT)
  • male = first void urine
  • female = vaginal swab, first void urine, endocervical swab
110
Q

chlamydia treatment

A
  • partner management
  • doxycycline or azithromycin for 7 days
  • community screening
111
Q

gonorrhoea diagnosis

A
  • microscopy of gram stained smears of genital secretions look for gram negative diplococci within cytoplasm (male urethra, female endocervix, rectum)
  • culture on selective medium
  • sensitivity testing
  • NAAT
112
Q

gonorrhoea treatment

A
  • surveillance of Abx sensitivities

- ceftriaxone with azithromycin

2A revision (10 decks)

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